A 42-year-old man presents with dyspnea and palpitations. Echocardiogram shows a dilated right ventricle with regional akinesis and normal left ventricle. ECG shows epsilon waves in V1-V3 and T-wave inversion in the right precordial leads. Which is the most likely diagnosis?
- A Pulmonary embolism
- B Brugada syndrome
- C Arrhythmogenic right ventricular cardiomyopathy (ARVC) ✓
- D Right ventricular myocardial infarction
Correct answer: C. Arrhythmogenic right ventricular cardiomyopathy (ARVC)
Explanation
ARVC is characterized by fibrofatty replacement of the right ventricular myocardium, leading to RV dilation, regional wall motion abnormalities, and ventricular arrhythmias. The epsilon wave (a small deflection after the QRS in V1-V3) and T-wave inversion in right precordial leads are major diagnostic criteria per the 2010 Task Force Criteria. Brugada syndrome shows characteristic ECG changes but normal cardiac structure. Pulmonary embolism does not cause RV structural remodeling or epsilon waves.
Reference: Braunwald's Heart Disease, 12th ed.
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